Abstract Details

Title Adherence to Blood Pressure Management Guidelines after Acute Stroke in the Florida Stroke Registry

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 142

Objective To determine whether Joint National Committee guidelines for BP treatment were followed at the time of discharge unless otherwise contraindicated.

Background Appropriate hypertension (HTN) management remains a cornerstone after acute stroke. We investigated adherence to guideline recommended blood pressure (BP) treatment in patients admitted with stroke in the Florida Stroke Registry (FSR), a Get With The Guidelines based registry.

Design/Methods We included 194,274 cases from the FSR between Jan 2010 to Dec 2019 and recorded BP medication use at discharge. We established the following criteria to determine whether Joint National Committee guidelines for BP treatment were followed at the time of discharge unless otherwise contraindicated: 1) avoidance of beta blockers (BB) as first or second line therapy unless a compelling cardiac indication (CCI); 2) use of ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs) as first line in diabetes; and 3) use of diuretics or calcium channel blockers (CCB) as first line therapy in African Americans (AA).

Results Mean age 70±14 years, 50% female, 63% Non Hispanic (NH)-white, 18% AA, 19% Hispanic. HTN was present in 92% with 7% newly diagnosed. AA were less likely to be newly diagnosed compared to NH Whites (OR 0.73, 95%CI 0.66-0.80). In those 26% with CCI, 17% were not discharged on a BB; 9% of cases had BB as first line without a CCI. Diabetes was present in 32%, and an ACEI or ARB was not used in 33% of diabetics. Among AA, 45% did not receive a diuretic or CCB. At discharge, 20% of cases not diagnosed with HTN had a BP >140/90.

Conclusions In this large, hospital-based stroke registry, we identified several gaps in the guideline driven management for hypertension after acute stroke. There is an opportunity for quality performance improvement in stroke care delivery by drawing attention to this important clinical management issue

Authors/Disclosures
Gillian L. Gordon Perue, MD, F�鶹��ýӳ�� (University of Miami) PRESENTER	The institution of Dr. Gordon-Perue has received research support from CDC Paul Coverdell Grant. The institution of Dr. Gordon-Perue has received research support from Florida Department of Health. Dr. Gordon-Perue has received personal compensation in the range of $500-$4,999 for serving as a Moderator with PRIME ECHO Stroke �鶹��ýӳ��al Webinar.
Antonio Bustillo (University of Miami)	No disclosure on file
Carolina Gutierrez	Carolina Gutierrez has nothing to disclose.
	No disclosure on file
Hannah Gardener, ScD (University of Miami)	Ms. Gardener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intersocietal Accreditation Commission. Ms. Gardener has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ellipse Analytics. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Baum Hedlund. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with A Green Slate Consulting.
	No disclosure on file
Erika T. Marulanda, MD, F�鶹��ýӳ�� (University of Miami)	Dr. Marulanda has nothing to disclose.
Nicole B. Sur, MD (University of Miami)	Dr. Sur has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Sur has received research support from Florida Stroke Registry. The institution of Dr. Sur has received research support from Miami CTSI & NIH/NINDS.
	No disclosure on file
Tatjana Rundek, MD, PhD	The institution of Dr. Rundek has received research support from NIH.
Ayham M. Alkhachroum, MD (Columbia University Medical Center)	The institution of Dr. Alkhachroum has received research support from Miami CTSI.
Jose G. Romano, MD, F�鶹��ýӳ�� (University of Miami, Miller School of Medicine)	Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NHLBI.
Negar Asdaghi, MD (University of Miami)	Dr. Asdaghi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.
Ralph L. Sacco, MD, MS, FAHA	Dr. Sacco has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Sacco has received research support from NIH, NINDS, NCATS, NIMHD. The institution of Dr. Sacco has received research support from FL Department of Health. Dr. Sacco has received research support from University of Washington, Seattle. Dr. Sacco has received publishing royalties from a publication relating to health care.
Sebastian Koch, MD (University of Miami)	Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.

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